Espanioli Alexis, van den Hoogen Nynke J, Kuziek Jonathan, Sjonnesen Kirsten, Noel Melanie, Orr Serena L
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Headache. 2025 Sep;65(8):1369-1380. doi: 10.1111/head.15039. Epub 2025 Sep 1.
This study explored the relationship between pain catastrophizing and migraine-related outcomes (i.e., migraine-related disability and headache frequency) between visits with a neurologist in a clinical population of children and adolescents with migraine.
Evidence from adult populations suggests that pain catastrophizing, the tendency to magnify the threat value of, and ruminate and feel helpless about, pain may be associated with migraine-related outcomes, but the association in children and adolescents is less clear.
In this prospective longitudinal clinical cohort study, children and adolescents aged 8-18 years with migraine completed headache questionnaires and a validated measure of pain catastrophizing (Pain Catastrophizing Scale for Children) at baseline and initial follow-up visits with a neurologist. Recruitment spanned from May 2019 to July 2023. Headache frequency and migraine-related disability (Pediatric Migraine Disability Assessment) were assessed at both visits. Migraine outcomes at follow-up were examined in relation to baseline pain catastrophizing scores in models that controlled for sex, age, preventive treatment use, baseline headache frequency, and baseline disability.
For this study, 121 consenting participants were included. In models adjusted for age, sex, baseline headache frequency, baseline disability, and preventive treatment use, baseline pain catastrophizing scores were significantly associated with disability scores at follow-up (β = 0.81, 95% confidence interval [CI] = 0.13-1.48, p = 0.020), but not with headache frequency at follow-up (β = 0.04, 95% CI = -0.10 to 0.19, p = 0.575). When examining the specific subscales of pain catastrophizing in an adjusted model, only baseline pain magnification (β = 6.73, 95% CI = 2.95-10.51, p = 0.001) had a significant association with disability at follow-up, while feelings of helplessness (β = 0.08, 95% CI = -2.11 to 2.27, p = 0.944) and rumination did not (β = -1.83, 95% CI = -4.22 to 0.56, p = 0.133). In a subset of participants with pain catastrophizing measured at both visits (n = 65), pain catastrophizing total and subscale scores did not significantly differ between visits.
Baseline pain catastrophizing scores were associated with migraine-related disability, but not headache frequency, at follow-up in a clinical population of children and adolescents with migraine. Pain magnification specifically appeared to drive this association. Future studies should aim to replicate our results and to investigate if interventions aimed specifically at reducing pain magnification may help to mitigate migraine-related disability in children and adolescents.
本研究探讨了在患有偏头痛的儿童和青少年临床群体中，就诊期间疼痛灾难化与偏头痛相关结局（即偏头痛相关残疾和头痛频率）之间的关系。
来自成年人群体的证据表明，疼痛灾难化，即夸大疼痛的威胁价值、反复思考并对疼痛感到无助的倾向，可能与偏头痛相关结局有关，但在儿童和青少年中的关联尚不清楚。
在这项前瞻性纵向临床队列研究中，8至18岁患有偏头痛的儿童和青少年在基线和首次随访就诊时，完成了头痛问卷以及一项经过验证的疼痛灾难化测量工具（儿童疼痛灾难化量表）。招募时间跨度为2019年5月至2023年7月。在两次就诊时均评估了头痛频率和偏头痛相关残疾（儿童偏头痛残疾评估）。在控制了性别、年龄、预防性治疗使用情况、基线头痛频率和基线残疾的模型中，研究了随访时的偏头痛结局与基线疼痛灾难化评分之间的关系。
本研究纳入了121名同意参与的参与者。在调整了年龄、性别、基线头痛频率、基线残疾和预防性治疗使用情况的模型中，基线疼痛灾难化评分与随访时的残疾评分显著相关（β = 0.81，95%置信区间[CI] = 0.13 - 1.48，p = 0.020），但与随访时的头痛频率无关（β = 0.04，95% CI = -0.10至0.19，p = 0.575）。在调整模型中检查疼痛灾难化的具体子量表时，只有基线疼痛放大（β = 6.73，95% CI = 2.95 - 10.51，p = 0.001）与随访时的残疾有显著关联，而无助感（β = 0.08，95% CI = -2.11至2.27，p = 0.944）和反复思考则没有（β = -1.83，95% CI = -4.22至0.56，p = 0.133）。在两次就诊时均测量了疼痛灾难化的参与者亚组（n = 65）中，就诊之间疼痛灾难化总分和子量表得分没有显著差异。
在患有偏头痛的儿童和青少年临床群体中，基线疼痛灾难化评分与随访时的偏头痛相关残疾有关，但与头痛频率无关。疼痛放大似乎是这种关联的具体驱动因素。未来的研究应旨在重复我们的结果，并调查专门针对降低疼痛放大的干预措施是否有助于减轻儿童和青少年的偏头痛相关残疾。
